Healthcare

Amends the Medicare-Medicaid Alignment Initiative (MMAI) Nursing Home Residents' Managed Care Rights Law of the Illinois Public Aid Code. Provides that the Article applies to a fully integrated dual eligible special needs plan and any managed care plan for persons who are dually eligible for Medicare and Medicaid. Adds to the definition of "Demonstration Project", a fully integrated dual eligible special needs plan and any managed care plan for persons who are dually eligible for Medicare and Medicaid. Provides that the Department of Healthcare and Family Services shall provide each managed care organization with the quarterly facility-specific nursing component (instead of RUG-IV nursing component) per diem along with any add-ons for enhanced care services, support component per diem, and capital component per diem effective for each nursing home under contract with the managed care organization. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides medical assistance coverage for sickle cell disease (rather than sickle cell anemia).

Amends the Medical Practice Act of 1987. Provides that a pediatric neurologist or any other physician who diagnoses autism in a child must provide to the child's family, at a follow-up appointment, a pamphlet listing autism-specific support services in the area.

Amends the Illinois Insurance Code. Makes changes to defined terms. Provides that a group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after January 1, 2026 shall provide coverage for evidence-based cancer imaging for individuals with an increased risk of cancer as recommended by the current National Comprehensive Cancer Network clinical practice guidelines. Provides that this coverage shall be provided without cost-sharing, and the requirements of the Act shall not apply to the extent that providing coverage would disqualify a high-deductible health plan from eligibility for a health savings account.

Amends the Substance Use Disorder Act. Provides that disclosure of nonexempt records protected under the Act may be disclosed for research activities under the Domestic Violence Fatality Review Act. Amends the AIDS Confidentiality Act and the Mental Health and Developmental Disabilities Confidentiality Act. Provides that staff and any designee of the Illinois Criminal Justice Information Authority, members of the Ad Hoc Statewide Domestic Violence Fatality Review Committee of the Illinois Criminal Justice Information Authority Board, and the regional domestic violence fatality review teams are entitled to receive, inspect, copy, and share HIV-related information of any person subject to a domestic violence fatality review as part of and in accordance with the provisions of the Domestic Violence Fatality Review Act. Provides that the information disclosed is subject to the confidentiality requirements of the Domestic Violence Fatality Review Act. Effective immediately.

Amends the Unified Code of Corrections. Creates the Tamms Minimum Security Unit Task Force. Provides for membership on the Task Force. Provides that the Task Force shall study the subject of a practical, efficient, and beneficial repurposing of the Tamms Minimum Security Unit and its property for the benefit of the public, including the possibility of providing mental health services, health services, public safety, law enforcement training purposes, fire services, medical training and any other option for repurposing that the Task Force deems appropriate. Provides that each member of the Task Force shall serve without compensation. Provides that the Task Force shall meet 2 times per year or at the call of the Chairperson. Provides that the Department of Corrections shall provide administrative support to the Task Force. Provides that the Task Force shall submit a report to the Governor and the General Assembly on or before December 31, 2025 with its recommendations and is dissolved on January 1, 2026. Repeals these provisions on January 1, 2026. Effective immediately.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires hospitals and birthing centers to adopt and maintain written policies and procedures authorizing a patient enrolled in the medical assistance program to select an Illinois Medicaid certified and enrolled doula of the patient's choice to accompany the patient within the facility's premises for the purposes of providing support before, during, and after labor and childbirth, and during the patient's entire postpartum stay. Provides that the doula shall be considered part of the patient's care team and shall not be counted as a support person or against any guest quota. Requires hospitals and birthing centers to provide a written copy of their policies and procedures to maternity patients, the facilities' maternity health care providers, and any other person at the patient's request. Requires publication of the written policies on each facility's website. Contains provisions concerning hospital and birthing center liaisons and doulas certification acknowledgment requirements. Permits the Department of Healthcare and Family Services and the Department of Public Health to establish standing recommendations to meet Centers for Medicare and Medicaid Services requirements and ensure access to preventive services, including Medicaid-covered maternal and reproductive health supports and services.

Amends the Prior Authorization Reform Act and the Illinois Public Aid Code. Provides that a health insurance issuer, the fee-for-service medical assistance program, and a Medicaid managed care organization may not require prior authorization for the following prescription drug types and their therapeutic equivalents approved by the United States Food and Drug Administration: human immunodeficiency virus pre-exposure prophylaxis and post-exposure prophylaxis medication or human immunodeficiency virus treatment medication. Effective January 1, 2027.

This House Resolution declares May 10 through May 16, 2026, as Prevention Week in Illinois to raise awareness about substance use prevention and mental health. The measure directly affects community organizations, schools, and families involved in prevention efforts across the state. It formally recognizes the work of local coalitions and agencies that promote safe, healthy communities and commends their contributions to reducing youth substance use. Copies of the resolution will be presented to numerous prevention groups and partners who support these initiatives.

Urges the Illinois Department of Healthcare and Family Services (HFS) to ensure that pharmacies participating in Medicaid managed care networks are reimbursed for covered outpatient prescription drugs at a rate no less than the reimbursement that would be paid under the Illinois Medicaid fee-for-service pharmacy program. Urges HFS to implement such reimbursement parity through Medicaid managed care organization contracts and pharmacy benefit manager agreements. Urges HFS to monitor and report to the General Assembly on the impact of reimbursement parity on pharmacy network participation, patient access to medications, and pharmacy closures within the State. Encourages HFS to evaluate the effect of reimbursement parity on pharmacy deserts, rural health access, and Medicaid beneficiary access to pharmacist-provided patient care services.